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Archive for ‘Strengthening Health and Social Systems’

MannionDaniels has been contracted by Mott MacDonald to undertake two critical reviews for the DFID-funded Evidence for HIV Prevention in Southern Africa Programme.

The reviews focus on HIV prevention for adolescents with the aim of producing two discussion papers that will contribute to and broaden regional debates on issues affecting policy and programming on HIV prevention for adolescents in the Eastern and Southern Africa Region.

The topics of the discussion papers are:

  • The future of social and behaviour change communication (SBCC) in an era of combination prevention; and
  • The impact and value of a more nuanced and disaggregated definition of ‘adolescents’ for HIV prevention programming

The two discussion papers are in the final stages of development. The preliminary findings have been presented at a Technical Forum, hosted by EHPSA in Cape Town in September, with Alex le May present. Participants included researchers, multilaterals, donors, civil society organisations and representatives of national ministries of health and education, national AIDS commissions, and regional bodies.

Further information on the event can be found here on the EHPSA website.


Cord are a peacebuilding organisation who have been supported by a UK Aid Direct grant to implement a WASH programme in Burundi providing access to clean drinking water, improved sanitation and health over a three year period.

The Burundi project has impacted over 139,000 people. In this case study, Cord reflect upon the significant factors that contributed to the project’s success and focus on the unintended positive outcomes, which we can draw lessons from for future programmes, particularly those which support peacebuilding objectives in the field of poverty reduction.

A ‘do no harm’ analysis at the project design stage helped shape the programme in a more inclusive and participatory way.

Involving communities in working together to identify the most vulnerable people enabled a discussion which was both impartial and objective. When identifying for example, where to place a water point, communities asked:

‘By placing the water point here, how might it divide our community or how might it connect our community?’

‘Who would benefit most and who would benefit least? How can the maximum number of people benefit?’

Through such discussions, communities decided that everyone should have equal access to WASH facilities, which inspired other community members to build latrines by their own means.

This sense of community responsibility also extended to schoolchildren. Beyond the educational aspects of sanitation and hygiene, communities took on the challenge of improving sanitation conditions within their schools, leading to improved social cohesion and increased latrine usage in general.

The project was structured around community level Water Point Committees and local authority engagement, involving both men and women.

Another key success factor in the project was how decisions were structured around engagement between community level Water Point Committees, consisting of both men and women who managed the water points, and local authorities.

This approach mitigated potential for conflict early on so that challenges could be overcome through regular monitoring and dialogue.

Engaging local authorities had a positive impact beyond expectations. By involving them in joint monitoring activities with the communities, agreeing mutually where water points were located, validating the final list of water points together and holding regular joint reflection sessions, it was possible to learn and adjust the project activities.

Women’s self- esteem increased when they were part of the committees and those who were engaged in construction work reported that they felt more valued by their co-workers. In some instances, women subsequently reported a reduction in domestic violence because of their new role contributing to family income.

In addition to increased self–esteem and more peaceful household relations, gender roles were discussed within communities. This led some women to report that their husbands had become more supportive within the domestic sphere by carrying out tasks traditionally perceived as a women’s role, such as fetching water.

Having more accessible water points meant that young girls were able to attend school more regularly, as fetching water was also previously a role prescribed to them.

Future programmes could build more peacebuilding indicators into the project design

The focus of the Burundi project was a WASH intervention, therefore the peacebuilding and ‘do no harm’ aspect was monitored internally and on a more ad-hoc basis. For future programmes Cord recommend that key indicators, such as improving relationships within the home, decreasing gender-based violence and improving women’s self-esteem could be factored into the project design and donor reporting, regardless of the intervention’s primary focus.

Further general reflections conclude that the peacebuilding model and approach enabled the project to be reflected on in a more transformational way. For example, at the heart of the model was the interconnectedness of the ‘relational space for peace’, a method that Cord seek to support and enable in all contexts in which they work.

Many of the unexpected project outcomes related to this aspect of peacebuilding by creating spaces for dialogue using non-violent communication, resolving conflict through local capacities and building trust and respect to engage whole communities in challenging inequality and injustice together, working towards more peaceful and inclusive societies where all people can flourish.

Cord UK Aid Direct WASH intervention Burundi peacebuilding conflict prevention

The information in this article was compiled by Martina Hunt, Cord Learning Manager

Grant holders who are interested in knowledge-sharing and incorporating peacebuilding and conflict prevention efforts into their work are encouraged to contact Martina: mhunt@cord.org.uk

http://www.cord.org.uk/


Nnenna Ike, MannionDaniels’ Behaviour Change Communication Specialist, spoke at the MSH Anniversary Event in Abuja, Nigeria.

The event was held to celebrate the work on health system strengthening and community health interventions carried out by a variety of partners in Nigeria.

Nenna Ike MSH Talk

Nnenna’s talk focused on how to promote behaviour change in the community.  Based on MannionDaniels’ experience with the PATHS2 programme in Nigeria, we identified three key strategies:

  1. Inclusion:  If we want people to adopt healthy household behaviours, we have to involve some otherwise ignored informal players in the health sector such as traditional healers, traditional birth attendants and other key influencers in the community. They can feel intimidated by BCC that promotes early care-seeking because it threatens their livelihood.  We have brought them into the program as partners – rather than rivals – by taking their advice, by integrating their responses, and then by linking them to health facilities.  When they have a positive attitude towards health facilities, they promote early care-seeking to their clients.  This has increased the acceptance and utilisation of health facilities.
  2.  

  3. Acceptability:  Different states in Nigeria have different cultures.  When trying to improve the adoption of healthy household behaviours, we need to work respectfully and sensitively within those cultures and existing traditional structures.  This includes considering the language; in the North, we communicate the intervention in Hausa but have some PhD students in Bayero state University translating it into Arabic to make it more widely accessible.  In the South, messages have been translated into Yoruba and Igbo languages. We even have products in Pidgin English and Egun language (predominant in western Nigeria).  It also involves considering the cultural norms around men and women – for example, in the North, men and women meet separately, whilst in the South they can meet together for community meetings. Also, we incorporate BCC activities into to existing structures like the ‘August meetings’ and the women fellowships or pregnant women support groups in churches and mosques in the southern states.
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  5. Involving men: Men are the main decision-makers when it comes to maternal and reproductive health – so they are a very important group to promote early care-seeking to.  The volunteers in the Northern States we work in are largely men, they act as drivers, blood donors and manage the communal purse dedicated to obstetric emergencies.  In the South, there are male leaders in churches who are given responsibilities, for examples they pray with the women in the pregnancy support groups in churches; and women who go to health facilities with their husbands get a special mention by the health providers.

MSH Anniversary Event Nigeria group talk

 


UK Aid Direct M2MMalawi is one of the world’s least developed and most densely populated countries, with a population approaching 17 million.  An estimated 10% of the country’s adults between the ages of 15 and 49 are living with HIV and the majority of them are women.

Support from DFID’s UK Aid Direct global fund, aimed at supporting civil society organisations to achieve the Sustainable Development Goals, has enabled mothers2mothers (m2m) to create an extensive footprint in Malawi, where an estimated 560,000 women aged 15 and over are living with HIV. The essential health education and support that Mentor Mothers provide is critical to helping women cope with the shock and stress of learning that they are HIV-positive and are being put on a lifelong ARV treatment in a single visit to the health facility. Mentor Mothers continue to provide support to the women in the years that follow in order to help them stay on treatment, minimize the risk of transmission, and make healthy choices for their families.

mothers2mothers Malawi UK Aid Direct Mentor Mothers

Catherine Kassam, PMTCT Coordinator at the Malawi Ministry of Health, discussed the importance of Mentor Mothers and the role they play in creating a generation free from HIV:

mothers2mothers Catherine Kassam Malawi Ministry of Health PMTCT coordinator Malawi“The first time I heard about the mothers2mothers model, I was thinking maybe it would be a challenge. I thought the women [Mentor Mothers] would not be open enough to disclose their status. But after the training, I found them very open so that other women [clients] could cope. Mentor Mothers have helped a lot to assist other mothers to disclose their status, and we are seeing men getting involved in PMTCT. All facilities should have Mentor Mothers so that we can catch every community. And everyone in the community should know the importance of being tested. Those who are HIV-positive should start taking their ARVs, so that we can have a generation free of HIV.”

mothers2mothers UK Aid Direct Malawi Mentor Mothers

 

Grantee: mothers2mothers

Project title: Improving access to HIV prevention and support services for 243,949 women and children in five countries of East and Southern Africa

Location: Malawi

 


What policy and legal frameworks are needed for districts to enable local governments to deliver more equitable services?  What capacity-building needs does local government have in Somalia?  How can local governments be more accountable to and responsive to community priorities, with a special focus on equity?  MannionDaniels is about to start working with the Social Affairs Departments of selected districts in Somaliland and Puntland to try to answer these questions.  This is part of the UN Joint Programme on Local Governance and Decentralised Services (JPLG), which several UN partners contribute to.  MannionDaniels is looking forward to starting consultations and developing some practical solutions together with the selected Social Affairs Departments of Somaliland and Puntland.  This builds on previous work we have done on similar issues both in Kenya at local government level and in Somalia.